On Friday 13 March, I messaged a worried friend in the US: ‘There’s a lot of contradictory information about the situation in Italy.’ I was, of course, referring to the unfolding Covid-19 pandemic in Lombardy, northern Italy, which had prompted a regional lockdown on 8 March and a national lockdown on 11 March. We now know that as many as 15,000 people – about 0.1% of the population in this region – may have died of Covid-19 between 21 February and 28 March 2020.

When I sent this message I knew there was a pandemic, I knew that large numbers of people were contracting and dying from the infection and I was reading the scientific and medical literature and international news coverage. But at the same time, my tone reflected a wider cautiousness that I saw in my colleagues, the medical professional bodies and daily news which, at best, tried to prevent panic, and at worst paralysed any ability to acknowledge, plan and act in the face of the Covid-19 pandemic. Why didn’t we listen to what we were being told? This book is a good place to start to understand this.

Horton opens with an account of how Covid-19 spread ‘from Wuhan to the world’, starting the timeline with Li Wenliang, an ophthalmologist working in Wuhan, whose social media posts drew attention to the potential ‘SARS-like’ virus at the end of December 2019. Since this book was published, it has been suggested Covid-19 was already circulating internationally in December 2019. However, Horton’s chronology captures the way that first the Chinese government, then the World Health Organisation (WHO), then the world, reacted to and shared information about the virus.

There are important details about how the pandemic spread. Take ‘case 31’ from South Korea: a woman who travelled from Wuhan to Seoul and then to Daegu. Before her arrival in South Korea, the country had 30 reported cases and no deaths. Ten days later, that had jumped to 2,300. The ways that we eat, live and travel in a carbon-intensive economy are intricately linked to the form the pandemic has taken.

In addressing the question of ‘what’s gone wrong’, Horton goes back to the 2003 SARS outbreak. He considers this ‘the beginning of an entirely new geopolitical era’ of international co-operation in public health in the face of a ‘new security threat’, ‘whether naturally occurring or intentionally introduced’. The countries affected by SARS learnt from this previous experience: China, Taiwan, Hong Kong, Singapore (and also South Korea, albeit from dealing with MERS in 2015 [2]). But in Western Europe austerity, a focus of short-term political tasks, and a failure to prioritise pandemic planning [3] under mostly conservative or neoliberal regimes, sunk any possibility of a similarly co-operative public health plan, and instead steered a course towards lethal ignorance.

But even if an international action plan wasn’t possible – or desired – why were our own politicians so slow to act? Here Horton is uncompromisingly scathing. Just under a month from the declaration of a PHEIC (Public Health Emergency of International Concern), Boris Johnson held a press conference announcing a review of foreign policy, national security and defence without mentioning Covid-19. He failed to attend the initial COBRA (national emergency committee) meetings. On 3 March he declared that the UK ‘remains extremely well prepared’, which if he had read the unpublished 2016 Cygnus report [4] from NHS England, he would know we were not.

The escalating lockdown saw the advice change day by day, but no clear message emerged until 23 March, following epidemiologist Neil Ferguson’s paper from Imperial College London which modelled that hundreds of thousands of people would die without lockdown. This wasted precious time, which could have been used to learn from the international response and to prepare. Instead, the care sector and NHS workers were promised safe PPE, and were lied to about its availability, with recommendations from Public Health England reflecting availability, not WHO guidance. While Secretary of State for Health and Social Care Matt Hancock told the daily briefing ‘we are following the science’, other senior scientists thought otherwise: ‘Maybe there’s a strategy there, I don’t see it’, Nobel Laureate Sir Paul Nurse told BBC Radio 4’s The Today Programme.

And if our government was slow to act, what was the Labour Party, the medical professional bodies, universities, trade unions doing instead? Horton doesn’t give an answer to this, reflecting on how perhaps they didn’t read what was being said in China, perhaps they didn’t want to lose political favour, perhaps they didn’t believe that what was happening to their colleagues internationally could happen to them. But this epic failure of leadership wasn’t just present in these illustrious organisations – it was present in all our workplaces.

The only organisations that were able to deliver support in extremely difficult situations, and operated under conditions that were negotiated to ensure the people involved felt safe, were the neighbourhood Mutual Aid groups. And this is a theme throughout the book, that Horton looks to large organisations for top-down change. I disagree with his claim that ‘until the financial crisis [there was] a steady political alignment around a common global story: the need for greater international collaboration to solve some of the world’s most pressing problems.’ I think the lack of international collaboration to find a solution to climate change answers this one for itself. I also find the passing mention of HIV as another form of pandemic virus callous. Unlike for Covid-19, there are treatments available for HIV that prevent transmission, but they are not universally available, because of the pharmaceutical companies’ need for profit.

When a herd of cows come towards your picnic, some people look, take a photo, think, ‘That’s cute, they’re coming to eat our picnic’, and only when the cows are already eating their picnic, think, ‘What?! How has this happened? Why didn’t we move earlier?’.[1] I suppose this is what I blame myself for in my message from March, but then I’m not in charge, I’m not a boss, but I was certainly made to feel – like many people working in the NHS – that I was left to make decisions about my safety because of incompetency right from the top.

Stacey Williams

1. This actually happened recently to a group of socialists, including the reviewer, while discussing the Covid-19 pandemic.